Fertility and pregnancy outcomes following uterine artery embolization (UAE) for uterine arteriovenous malformation (AVM)

Abstract

A 19-year-old patient presented with intractable uterine bleeding, 11 weeks post-abortion. A pelvic ultrasound with Doppler and color imaging suggested a uterine arteriovenous malformation. Failing conservative therapies, the patient consented to uterine artery embolization (UAE). Two months later, she conceived and had an uneventful normal vaginal delivery at term. Since this is an extremely rare condition, allowing limited clinical exposure and experience, there may be an underlying reluctance by general practitioners to treat these cases with uterine artery embolization for fear of compromising future fertility and pregnancies. However, data from the 20 pregnancies embolized for uterine AVM cited in the present report and data from embolization for uterine fibroids indicate that such fears may be unfounded since pregnancy rates and outcomes may not be compromised after UAE.

Successful Pregnancy and Live Birth after Uterine Artery Embolization for Uterine AV Malformation—A Rare Entity: A Case Report

“…2 Burbank et al proposed that the stasis of blood flow caused by UAE induces clot formation in the uterus. 3 Fibrinolysis occurs in the normal myometrial vasculature followed by reperfusion. However, UAVMs, which are neovascular masses, lack proper fibrinolytic pathways leading to ongoing clots, stasis, and eventual regression.…”

“…However, UAVMs, which are neovascular masses, lack proper fibrinolytic pathways leading to ongoing clots, stasis, and eventual regression. 3 Acquired or traumatic AVM represents the multiple small arteriovenous fistulae between intramural arteries and myometrial venous plexus, that is, a single artery joining a single vein. Acquired AVM in our case is likely to result from an aberration at the molecular level, which is due to trauma from the curettage resulting in improper regression of the placental bed, thus causing the venous sinuses to be incorporated in the myometrium.…”

“…Acquired AVM in our case is likely to result from an aberration at the molecular level, which is due to trauma from the curettage resulting in improper regression of the placental bed, thus causing the venous sinuses to be incorporated in the myometrium. 3 This activates the myometrial vascular endothelial growth factor, proinflammatory, and angiogenesis factors thereby creating a local immune response.…”

Term Pregnancy after Unilateral Uterine Artery Embolization for Aggressive Uterine Arteriovenous Malformation

“…Copy@ Korbel Miroslav placental abruption and premature delivery also after UAE due to AVMs [15,16]. In previously published papers, various embolic agents and their combinations such as glue, gelatin foam, coils, PVA particles, NBCA, Onyx and microspheres have been used for UAE in patients with AVMs.…”